title: Patterns of care and persistence after incident elevated blood pressure.
abstract: OBJECTIVE
  Screening for hypertension in children occurs during routine care. When blood pressure (BP) is elevated in the hypertensive range, a repeat measurement within 1 to 2 weeks is recommended. The objective was to assess patterns of care after an incident elevated BP, including timing of repeat BP measurement and likelihood of persistently elevated BP.
  
  
  METHODS
  This retrospective study was conducted in 3 health care organizations. All children aged 3 through 17 years with an incident elevated BP at an outpatient visit during 2007 through 2010 were identified. Within this group, we assessed the proportion who had a repeat BP measured within 1 month of their incident elevated BP and the proportion who subsequently met the definition of hypertension. Multivariate analyses were used to identify factors associated with follow-up BP within 1 month of initial elevated BP.
  
  
  RESULTS
  Among 72,625 children and adolescents in the population, 6108 (8.4%) had an incident elevated BP during the study period. Among 6108 with an incident elevated BP, 20.9% had a repeat BP measured within 1 month. In multivariate analyses, having a follow-up BP within 1 month was not significantly more likely among individuals with obesity or stage 2 systolic elevation. Among 6108 individuals with an incident elevated BP, 84 (1.4%) had a second and third consecutive elevated BP within 12 months.
  
  
  CONCLUSIONS
  Whereas >8% of children and adolescents had an incident elevated BP, the great majority of BPs were not repeated within 1 month. However, relatively few individuals subsequently met the definition of hypertension.
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado 80231, USA. matthew.f.daley@kp.org
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Daley
authors.forename: Alan R
authors.initials: AR
authors.lastname: Sinaiko
authors.forename: Liza M
authors.initials: LM
authors.lastname: Reifler
authors.forename: Heather M
authors.initials: HM
authors.lastname: Tavel
authors.forename: Jason M
authors.initials: JM
authors.lastname: Glanz
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.forename: Emily
authors.initials: E
authors.lastname: Parker
authors.forename: Nicole K
authors.initials: NK
authors.lastname: Trower
authors.forename: Malini
authors.initials: M
authors.lastname: Chandra
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Sherwood
authors.forename: Kenneth
authors.initials: K
authors.lastname: Adams
authors.forename: Elyse O
authors.initials: EO
authors.lastname: Kharbanda
authors.forename: Louise C
authors.initials: LC
authors.lastname: Greenspan
authors.forename: Joan C
authors.initials: JC
authors.lastname: Lo
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008403:Mass Screening; D010818:Practice Patterns, Physicians'; D058246:Prehypertension / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D014481:United States
keywords: adolescent; blood pressure; child; electronic health records; hypertension; screening